枕骨板障间螺钉固定枕颈融合术治疗颅颈部畸形

目的探讨枕骨板障间螺钉固定枕颈融合术治疗颅颈部畸形的临床疗效。方法回顾性分析2010年1月—2013年1月南华大学附属第一医院收治的15例颅颈部畸形患者资料，其中男9例，女6例，年龄29～60岁（40．4±8．2）岁。Amdd—Chiari畸形8例，寰枕融合并颅底扁平5例，颈椎分节不全（Klippel—Feil综合征）2例。术前CT和MRI检查均提示寰枢椎脱位合并脊髓不同程度受压。术前日本矫形外科协会（JOA）评分为6～10分，平均（8．1±1．7）分。所有患者人院后均行颅骨持续牵引，均采用枕骨板障间螺钉固定系统进行枕颈融合术。结果手术均顺利完成，手术时间100—220min（140．2±30．5）min；出血量190～710ml（272．2±73．4）ml。无脊髓血管损伤及其他严重并发症。术后第3天JOA评分9—14分，平均（11．0±2．1）分，较术前明显改善（t=0．003，P〈0．05）。术后复查X线片、CT和MRI提示板障间螺钉位置均满意，没有螺钉穿透枕骨内板。除1例复位不良外，余14例均完全复位，脊髓受压完全解除。随访12～36个月，平均（22．0±6．3）个月，术后3—9个月（5．1±2．7）个月植骨均获得骨性融合，无断钉、断棒及内固定松动发生。末次随访时JOA评分为12—16分，平均（14．1±1．6）分。与术前比较明显改善，差异有统计学意义（t=0．002，P〈0．05）。结论颅骨持续牵引结合枕骨板障问螺钉固定系统进行枕颈融合术具有固定牢靠、操作简单、方便植骨等优点，是治疗颅颈部畸形的有效方法。

Treatment of craniovertebral anormalies through occipitocervical fusion by inter-diploe screw fixation

Objective To explore the clinical outcome of the treatment of craniovertebral anormalies through occipitocervical fusion by inter-diploe screw fixation. Methods From January 2010 to January 2013, 15 patients （9 males, 6 females） in the First Affiliated Hospital of University of South China were diagnosed with eraniovertebral anormalies. The age ranged from 29 to 60 years （40.4 ± 8.2 ） years. Eight patients had Arnold-Chiari deformitory, 5 patients had basilar invagination with os odontoidem, 2 patients had Klippel-Feil deformitory. All the patients had symptoms of spinal medulla compression. The Japanese orthopaedic association（JOA） score of preoperation ranged from 6 to 10 （8. 1 ± 1.7 ）. All the patients received head-shoulders traction through modified Halo-vest for 1 -2 weeks. All cases received occipitocervical fusion by inter-diploe screw-rod-pedicel screw system. Results All patients underwent this technique operation successfully. The mean operation time was 100 - 220 min（ 140.2 ± 30.5 ） rain, and blood loose was 190 -710 ml（272.2 ±73.4） ml. There was no neurological function worsen and severely complications. The JOA after operation 3 days was 9 - 14 （ 11.0± 2.1 ） , there was statistical differences compared to preoperation （ t = 0. 003, P 〈 0.05 ）. The postoperatively radological films indicated all the inter-diploe screw locations were satisfactory, there was no screw penetrating the medial occipital plate. All eases were followed up for 12 - 36 months （ 22.0 ± 6.3 ） months. Bone graft fusion was obtained in 3 - 9 months （5.1 ± 2.7 ） months. There was no internal fixation breakage and loosening. The JOA score of last follow-up was 12 -16 （14.1 ± 1.6） , there was statistical differences compared to preoperation（ t =0.002, P 〈 0.05 ）. All patients with limb numbness, muscle weakness and other symptoms were obviously improved than preoperation. Conclusions Occipitocervical fusion using inter-diploe screw-rod-pedicel screw system, is an effective m